Brain Health: Integrating Mind, Brain, Body, Behaviors, and Spirituality

In today’s world, the practice of medicine focuses primarily on diagnosis and treatment of symptoms.  While this approach may be adequate when dealing with illnesses like Strep throat or high blood pressure, this narrow approach often falls short when it comes to more complex, chronic or progressive neurological and psychiatric disorders.  Although we have made considerable advances in neuroscience over the last few decades, we still have only a rudimentary understanding of what causes most neuropsychiatric disorders.  In addition, we lack reliable diagnostic tests for most neuropsychiatric disorders and typically identify them late in the course of illness.  Treatments are limited in terms of their ability to mitigate symptoms and most individuals with disorders like Alzheimer’s disease live with symptoms that are disabling and profoundly impact their quality of life.  

In a recent article published in the New England Journal of Medicine Catalyst Innovations in Care Delivery, members of the Center for Health Outcomes and Interdisciplinary Research (CHOIR), including Ryan Mace, PhD, Victoria Grunberg, PhD, and Ana-Maria Vranceanu, PhD, discuss how we can improve long-term care for patients with neuropsychiatric disorders, redefining brain health as “the promotion of health and well-being across the lifespan through the integration of mind, brain, body, behaviors, and spirituality.”

Interdisciplinary programs, such as the Center for Health Outcomes and Interdisciplinary Research (CHOIR) at the Mass General, are broadening our approach to illness and are prioritizing the development of evidence-based, holistic, and person-centered interventions which focus on (1) preventing rather than just treating neurological and psychiatric illness, (2) promoting optimal brain functioning rather than eliminating disability, and (3) enhancing quality of life rather than prioritizing increased lifespan.

One example of this approach is My Healthy Brain (MHB), a group-based multimodal lifestyle program designed to promote brain health in older adults with cognitive decline.  In a proof-of-concept study, Mace and colleagues recruited older adults with subjective (self-reported) or objective (confirmed by cognitive testing) cognitive decline who were referred by neurologists in order to modify lifestyle risk factors.  The 8-week MHB program consists of weekly 90-minute sessions and targets modifiable risk factors for dementia, including lack of physical activity, social activity, poor sleep, use of alcohol, and diet.

In a non-randomized open pilot study of MHB, 24 participants completed the MHB program.  The pilot study demonstrated good feasibility of recruitment (71% of patients screened) and enrollment (75% completed baseline visit) and good acceptability of treatment (75% completed 6 of 8 sessions and post-testing). Program satisfaction was excellent (100% of participants), and no adverse events were reported.  Most importantly, the researchers observed improvements in lifestyle behaviors, as well improvements in self-determination and subjective well-being.

Moving Forward

Neurological and psychiatric illnesses are now the leading causes of disability and death worldwide, affect over 100 million Americans, and cost the U.S. healthcare system over $800 billion each year.  While there has been an intense focus on developing new treatments for Alzheimer’s disease and other neurodegenerative disorders, the results have been profoundly disappointing.  

Mace and colleagues note that shifting the focus from treatment to the prevention of neurological and psychiatric illnesses would reduce the prevalence of these disorders, decrease health care expenditures, and improve outcomes and quality of life. Preventative strategies are widely available for other illnesses such as cancer and heart disease but not for brain health.  Interventions that emphasize modifiable risks and provide individuals with education and the tools to change behaviors are long overdue.

Acknowledgement:The authors would like to thank Joshua Roffman, MD, Jonathan Rosand, MD, and Stephanie Peabody, PsyD, HSPP, for their contributions to the brain health initiatives featured in this article. 

Mace RA, Grunberg VA, Vranceanu AM.  Redefining Brain Health: A Call to Embrace a Biopsychosocial Approach.

Mace RA, Hopkins SW, Reynolds GO, Vranceanu AM.  My Healthy Brain: Rationale and Case Report of a Virtual Group Lifestyle Program Targeting Modifiable Risk Factors for Dementia.  J Clin Psychol Med Settings. 2022 Jan 25:1-13. 

Mace RA, Greenberg J, Stauder M, Reynolds G, Vranceanu AM. My Healthy Brain: a multimodal lifestyle program to promote brain health. Aging Ment Health. 2022 May; 26(5):980-991. 

Mace RA, Popok PJ, Hopkins SW, Fishbein NS, Vranceanu AM.  Adaptation and virtual feasibility pilot of a mindfulness-based lifestyle program targeting modifiable dementia risk factors in older adults.  Aging Ment Health. 2022 Feb 1:1-13.